Literature Review

Palliative care in the ED reduces costs, improves patient outcomes Hospice News; by Jim Parker; 10/28/24 The presence of an embedded palliative care practitioner in the emergency department can significantly improve patient outcomes and reduce costs. A pilot program at the Michigan-based Corewell Health system in which a palliative physician was embedded in the ED effectively reduced inpatient mortality, readmissions, intensive care unit utilization and the total cost of care, while also boosting staff satisfaction, Lisa VanderWel, senior director for Corewell Health Hospice and Palliative Care, said during a presentation at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference in Denver. ... “When you do really good palliative care, what happens?” she said during the presentation. “You have those [goals-of-care] conversations in a more timely manner. You have an earlier conversion to hospice. You avoid all the stress and crisis that’s involved if you wait until the last minute.”

Saint Francis Hospital’s Healthy Village creates national social-services healthcare model DelawareLive, Wilmington, DE; by Jarek Rutz; 10/23/24 Saint Francis Hospital hopes a new, unique initiative will be a national model for healthcare. As it celebrates 100 years of service, the hospital is expanding its community outreach to the Wilmington community by launching the Healthy Village at Saint Francis Hospital, which aims to deliver essential social services to those in need. Located in economically challenged neighborhoods, Healthy Villages are designed to enhance the traditional safety net hospital model. “The goal is to create the ultimate one-stop care setting that promotes synergy, diversity, and equity,” said Lillian Schonewolf, executive director of the Healthy Village at Saint Francis, in a YouTube video. Editor's note: See the article we posted yesterday about the importance of community, "Who gets access to a good death?"

Duke Health CFOs' plan to reach 1 in 4 North Carolinians Becker's Hospital CFO Report; by Madeline Ashley; 10/21/24 Since Lisa Goodlett was named senior vice president, CFO and treasurer of Durham, N.C.-based Duke University Health System in March, one of the health system's main goals has been to increase access to the health system from 8% of North Carolina's population to more than 25%. To achieve this, the health system is leveraging technology and looking at expanding partnerships to ensure services are more widely available. ... As Duke Health continues to push expanded care access, the health system has also been in contract negotiations with UnitedHealthcare for the last few weeks regarding 172,000 of its patients.  ... If the parties cannot come to an agreement by Nov. 1, Duke Health's hospitals, facilities and physicians would be out of network for employer-sponsored commercial plans, including UMR and Medicare Advantage plans, including a group retiree and dual special-needs plans.

Florida health system rolls out virtual nursing tech to 1K rooms Becker's Health IT; by Giles Bruce; 10/17/24 Fort Myers, Fla.-based Lee Health is expanding virtual nursing technology to nearly 1,000 patient rooms, representing about half its beds. The four-hospital system is rolling out dual-camera virtual care devices from telehealth company Caregility to scale its virtual nurse offering. The remote fleet management tools come with artificial intelligence capabilities and cloud-based updates. "Our virtual nursing program introduces innovative possibilities in patient care workflows by connecting the care in the complex patient journey," Lee Health Chief Nursing Officer Jennifer Higgins, DNP, RN, said in an Oct. 16 statement. "From admissions and discharges to continuous patient monitoring, patients benefit from an additional team member dedicated to their care."

Poetry, again, confronts death JAMA; by Rafael CAmpo, MD, MA; 10/16/24Poetry can help physicians in many ways at the border between life and death. Though we might think first of the consoling power of elegy in confronting mortality, other poems, like “Again,” [referenced] aid us in wrestling with what death is in the first place—and are even more useful when research falls short in attempting to demystify it. One such scientific controversy surrounds in-hospital resuscitation, especially for older adults, with studies showing inconsistent rates of meaningful survival after these potentially life-saving interventions, confounded by the physical and emotional trauma that accompanies them, poor understanding of patients’ and families’ wishes, unclear definitions of “meaningful,” and varying patient selection criteria. [The poem titled] “Again” distills some sense out of this complexity as only poetry can, with the urgent repetition of “again” expressing the ingrained imperative to act when patients experience cardiac arrest while echoing both the many previous resuscitations hospital staff well remember, along with the 2-beat, up-down muscle memory of performing chest compressions. ... Thus, a reflexive, futile endeavor becomes a human being’s dying moment, allowing us to feel closure. Debates around in-hospital resuscitation suddenly quieted, we recognize life’s inevitable finality, underscored by the poem’s ironically dignified resignation in its concluding line: “Never again did you wake.”Editor's note: Click here to access the poem, "Again."

Estes Park's only hospital joining UCHealth System Fort Collins Coloradoan; by Kelly Lyell; 10/17/24 Estes Park Health has started the process of joining the UCHealth System, with an expected starting date in the spring of 2025, the two organizations announced in a joint news release Wednesday. ... Estes Park Health has been financially challenged in recent years to maintain its services, the news release said, citing problems hospitals across the country have had keeping up with “dramatically increasing expenses, rising uncompensated care and minimal increases in reimbursements from Medicare and Medicaid.” As a result, the only hospital serving the Estes Valley, including visitors to Rocky Mountain National Park, has had to transfer or reduce its obstetrics, home health and hospice services.Editor's note: We've been following this story as but one of many examples of rural healthcare examples that result in reduced utilization for hospice services.

4 trends in healthcare executive pay Becker's Hospital Review; by Kelly Gooch; 10/15/24 A 2024 survey conducted by SullivanCotter highlights a range of trends in healthcare executive pay, including a year-over-year jump in median base salaries. The consulting firm's "2024 Healthcare Management and Executive Compensation Survey" is based on data from more than 3,300 organizations representing nearly 45,110 executives and managers. Here are four trends from the survey, which was conducted from January to April:

2,400 Kaiser mental health workers to begin open-ended strike: 6 things to know Becker's Hospital Review; by Kelly Gooch; 10/11/24 Members of the National Union of Healthcare Workers are set to begin an open-ended strike Oct. 21 at Kaiser Permanente locations in Southern California. Six things to know:

Deals: Tracking mergers, acquisitions, partnerships in healthcareModern Heathcare; by Modern Healthcare staff;  10/10/24, 10:40am ET 

Home health providers, CMS raise red flags over delayed access Modern Healthcare; by Diane Eastabrook; 10/11/24 Delayed home health access for Medicare beneficiaries is increasingly raising alarms from the Centers for Medicare and Medicaid Services and the home health industry as providers place blame on staff shortages and the program's reimbursement rates. More than a third of Medicare fee-for-service beneficiaries referred to home health following hospitalizations did not receive services within seven days of discharge, according to an analysis of 2023 Medicare claims from healthcare analytics company CareJourney. The report echoes a similar study published by the Commonwealth Fund in July, as well as concerns CMS raised about access in its proposed 2025 home health pay rule. ... Years of low Medicare reimbursements are taking a toll on the home health companies trade groups represent, said William Dombi, president emeritus of the National Association of Home Care and Hospice, which is part of the National Alliance for Care at Home, and Cunningham.

A quality improvement initiative for inpatient advance care planningJAMA Health Forum; Olivia A Sacks, Megan Murphy, James O'Malley, Nancy Birkmeyer, Amber E Barnato; 10/24The Centers for Medicare & Medicaid Services (CMS) implemented advance care planning (ACP) billing codes in 2016 to encourage practitioners to conduct and document ACP conversations, and included ACP as a quality metric in the CMS Bundled Payments for Care Improvement Initiative in 2018. Increased ACP billing rates were significantly associated with decreased rates of inpatient death in the intervention group ... compared to the nonintervention ... and control groups ... Conclusions and relevance: This nationwide cohort study suggests that while the ACP quality initiative increased ACP billing, changes in clinical outcomes were inconsistent with the hypotheses.

Palliative and hospice care in the prehospital setting

Maryland hospitals face IV shortage as hurricanes hit suppliers The Baltimore Banner; by Sapna Bansil; 10/10/24 Hospitals across Maryland are scrambling to conserve IV fluids after damage from Hurricane Helene last month halted production at the country’s leading manufacturer and triggered a national shortage — which could worsen as Hurricane Milton drenches Florida this week. Baxter International shut down its plant in Marion, N.C., about 35 miles east of Asheville, after it experienced severe flooding and a nearby bridge collapsed. The facility produced 1.5 million bags a day and accounted for 60% of the nation’s supply of IV fluids, according to the American Hospital Association. Another key manufacturing plant, for B. Braun Medical in Daytona Beach, Florida, is in the path of Hurricane Milton. The company said that it planned to temporarily close the facility and that it had relocated its inventory farther north. In a statement posted to its website Wednesday, Baxter said that as it has ramped up production at its global facilities, most customers are now able to receive the majority of what they typically order. There is no timeline on when production will resume in North Carolina.